PALB2: Options for Cancer Treatment
Cancer Treatment for People with Inherited Mutations
Testing positive for an inherited PALB2 mutation may affect your treatment options or eligibility for clinical trials studying which treatments work best. The following are examples of situations where a PALB2 mutation may play a part in treatment decision-making.
Breast cancer surgical decisions
Because of the high risk for a second breast cancer diagnosis, women who are diagnosed with breast cancer who test positive for an in PALB2 may choose mastectomy rather than and radiation. Mutation carriers who undergo mastectomy are less likely to develop a second breast cancer.
PARP inhibitors for cancer treatment
PARP inhibitors are a type of that work by blocking a protein used to repair damaged . They were initially developed to treat cancers in people with an inherited or mutation. Since then, research and additional approvals have expanded use of PARP inhibitors to more situations. People with a PALB2 mutation who have been diagnosed with cancer may want to ask their doctor about therapy.
PARP inhibitors for and breast cancer
Although PARP inhibitors have not specifically received FDA approval to treat breast cancer in people with PALB2 mutations, the American Society of Medical Genetics released a paper suggesting that people with PALB2 mutations and cancer should be considered for the same treatments and clinical trials as people with a BRCA1 or BRCA2 mutation. Below are guidelines for PARP inhibitors for treating breast cancer in people with a BRCA1 or BRCA2 mutation.
- Treatment for metastatic breast cancer: The PARP inhibitors, Lynparza (also known as ) and (also known as ) both have received FDA approval for treating metastatic breast cancer caused by a mutation.
- Treatment for early-stage breast cancer: Based on results from a large clinical trial, experts recommend one year of the PARP inhibitor olaparib for people with early-stage, breast cancer who have an inherited BRCA mutation and who are at high risk for recurrence.
PARP inhibitors for cancer (mCRPC)
The PARP inhibitors, Lynparza (olaparib) and Talzenna (talazoparib) have received FDA approval to treat metastatic, in people with a PALB2 or other gene linked to a certain type of DNA damage repair.
Clinical trials, such as NEPTUNE are looking at PARP inhibitors for treating early prostate cancer.
PARP inhibitors for advanced ovarian, or primary peritoneal cancer
Several PARP inhibitors have been approved to treat ovarian cancers at different stages of the disease. In some situations, a tumor known as an test ("") can help people with an inherited PALB2 mutation and advanced ovarian cancer learn if they may benefit from a PARP inhibitor.
- after treatment
- HRD testing can help women with an inherited PALB2 mutation and advanced ovarian cancer learn if they may benefit from the PARP inhibitor Lynparza (olaparib) in combination with bevacizumab as maintenance therapy after first-line platinum chemotherapy.
- is approved for maintenance therapy in women with advanced ovarian, fallopian tube, or primary peritoneal cancer who had a complete or partial response to first-line platinum-based chemotherapy. Zejula for maintenance therapy does not require an HRD test.
- Maintenance therapy after treatment of recurrent cancer
- Zejula and () are both approved for maintenance therapy in women with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in a complete or partial response to platinum based chemotherapy.
PARP inhibitors for pancreatic cancer
Although PARP inhibitors have not specifically received FDA approval to treat pancreatic cancer in people with PALB2 mutations, the American Society of Medical Genetics released a paper suggesting that people with PALB2 mutations and cancer should be considered for the same treatments and clinical trials as people with a BRCA1 or BRCA2 mutation. The PARP inhibitor Lynparza is FDA approved for maintenance treatment of pancreatic cancer in people with a BRCA mutation whose disease has not progressed after completing first-line platinum-based chemotherapy.
PARP inhibitors for other advanced cancers with no treatment options
If you have a PALB2 mutation and advanced cancer that no longer responds to standard therapy, you may want to talk with your doctor about whether you might benefit from treatment with a PARP inhibitor.
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NePtune: Using PARP Inhibitors Before Surgery in Localized Prostate Cancer
Clinicaltrials.gov identifier: NCT05498272
Study of the Drug Olvi-Vec in Women with Ovarian Cancer
Clinicaltrials.gov identifier: NCT05281471
Clinicaltrials.gov identifier: NCT06115499
New Treatment in People with Triple Negative Breast Cancer or Advanced Solid Tumors
Clinicaltrials.gov identifier: NCT06022029
Clinicaltrials.gov identifier: NCT05720039